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Washington rates for HCPCS B4152

Enteral Formula Nutritionally Complete Calorically Dense (Equal To Or Greater Ough An Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 6

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.38 / $0.44
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.66 / $90.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.37 / $0.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.40 / $0.57
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.59 / $0.96
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.50 / $0.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.82 / $1.25